1. Hearing Screening and Audiometer Tutorial

2. Anatomy of the Ear

3. How the Ear Works

4. Types of Hearing Loss
Conductive
Sensorineural
Mixed

5. Conductive Hearing Loss
Due to any dysfunction of the outer and/or middle ear
May be congenital or acquired
If left untreated, may result in a reduction of hearing at all frequencies
Ability to understand speech relatively unimpaired if made loud enough (decibels)

6. Sensorineural Hearing Loss
Due to impairment of inner ear
Sounds cannot be perceived or analyzed properly resulting from abnormality
of the hair cells in the cochlea, or
the nerve pathways from inner ear to brain
High pitched sounds are often affected which impacts ability to understand speech
Most notable are high frequency consonant sounds such as “f, s, th, k, p, h, ch, sh”
Loudness or decibels has nothing to due with inability to hear

7. Causes of Hearing Loss Conductive Sensorineural
Infection or inflammation of middle ear (otitis media is most common cause)
Excessive cerumen build-up in external auditory canal
Foreign body
Congenital malformation of outer or middle ear
Otosclerosis-a disease affecting the stapes ossicle of the middle ear
Sensorineural
Congental
Damage to developing embryo by disease or drugs
Acquired
Anoxia at birth
Disease, injury, toxic effects of drugs, fever
Head injury
Exposure to intense noise
Vascular disturbances
Meniere’s Disease (fluids in the inner ear are affected causing hearing loss and dizziness

8. Treatment of Hearing Loss
Conductive
Medical/surgical intervention
Treat infection
Remove cerumen or foreign body
Management if permanent
Hearing aids
Sensoineural
Medical intervention
Very limited – except in treatment of vascular dysfunction
Management
Hearing aids and auditory trainers
Speech reading and auditory training
Sign language
Cued speech

9. Comparison of Conductive and Sensorineural Hearing Loss
May speak excessively loud
Typically have trouble understanding speech sounds as sounds are distorted
Hear low frequency sounds better than high frequency
Greater intolerance of loud sounds
May speak softly
Ability to understand speech relatively unimpaired if loud enough
Tend to have same degree of hearing loss at all frequencies
High tolerance for loud sounds

10. Mixed Hearing Loss Both conductive and sensoineural components
Combination of causes and symptoms reflective of both types

11. What is an Audiogram?
A graphic representation of one’s hearing thresholds

12. Understanding Frequencies (Hz)
Thresholds are the softest sounds one can hear at a specific frequency (pitch)
Frequencies or pitches are graphed from left to right
Low pitches on the left
High pitches on the right

13. Understanding Hearing Levels (dB)
Loudness is graphed from top to bottom in hearing level (dB)
Soft sounds at the top
Loud sounds at the bottom

14. Audiogram of Familiar sounds

15. Degrees of Hearing Loss compared to dB of Common sounds
Profound: > 91 dB HL
Severe: dB HL
Moderately Severe: dB HL
Moderate: dB HL
Mild: dB HL
Slight: dB HL
Normal Hearing: dB HL

16. Hearing Loss Simulation

17. Understanding the Hearing Loss
Slight to Moderate Hearing Loss
Difficulty hearing faint or distant speech
Needs favorable seating
May benefit from speech reading instruction
May benefit from hearing aid
Moderate to Moderately Severe Hearing Loss
Conversational speech is just audible at distance of 3-5 feet
Use of hearing aid, auditory trainer, speech reading, favorable seating
Speech language therapy to aid the student in the communication skills
Usually requires 504 and/or IEP

18. Understanding Hearing Loss (cont.)
Severe Hearing Loss
May hear a loud sound from about one foot away
With use of a hearing aid and other listening devices, may recognize some speech sounds and detect environmental sounds
Speech language therapy will aid the student in communication skills
Requires 504/IEP

19. Understanding Hearing Loss
Profound Hearing Loss
May not be able to detect presence of even very loud sounds, except by vibration
Does not rely on hearing as primary channel for communication
May use amplification, plus all other services but may not be successful in producing adequate oral speech and language
Requires 504/IEP

20. Audiometers

23. School Hearing Screening Protocol
Plug in/turn on audiometer and let it warm up for 10 minutes before using.
Seat child facing away from screener/ audiometer
Screener puts head phones on student
Right = Red
Left = Blue
Instruct student to raise hand when he/she hears sound, informing child that the sound will become more faint
Start with Right ear, always!

25. School Hearing Screening Protocol
Set Audiometer at the following threshold to start:
Right ear
Frequency Hz
Loudness - 50 dB
Start test – Right ear, as 1000 Hz
Instruct student to raise hand when he hears the sound
Push “tone” button – hold for 1-2 seconds
Starting at 50 dB “trains” the student to hear the sound
Reduce Loudness to 30 dB, press tone
Reduce Loudness to 20 dB, press tone – this is the “0bjective” level

26. School Hearing Screening Protocol
Increase Frequency to 2000 Hz while maintaining loudness at 20 dB
Press tone
If student does not raise hand, i.e. hear the sound, increase dB by 10 to 30 dB, etc until student recognizes sound – record finding (right ear, Hz, 40 dB)
Increase frequency to 4000 Hz, starting at current decibel level, then decrease, if needed to objective level of 20 dB

27. School Hearing Screening Protocol
Change to screening left ear on audiometer
Maintain frequency of 4000 Hz, 20 dB
Then decrease to 2000 Hz at 20 dB
Then decrease frequency to 1000 Hz, at 20 dB
Test complete
Note:
Student does not need to raise same hand as side sound is hear
For younger students, consider making this a game – “cars in the garage – beep of the horn”

29. Care of your Audiometer
Instrument very sensitive to
Temperature
Movement/jarring
Moisture
Dust
Therefore
Maintain in warm, clean, dry environment
Apply dust cover when not in use
Pure Tone Audiometers required annual calibration by a certified technician

31. Tips about the Headphones
Eliminate any obstructions that could interfere with placement of the earphone cushion on the ear (i.e. hair, earring, eyeglasses, hearing aids, etc.).
Adjust the headband so that the earphone cushions are centered over the ears (RED on the right ear, BLUE on the left) and the receivers line up with the ear canals. The headband should rest firmly over the center of the head and place firm pressure on both ears.

33. From the Operating Instructions Manual for the Maico MA 39 Pure Tone Audiometer
An unvarying and uniform explanation to the person being tested will provide test results that are consistently high in reliability.
An explanation for pure tone or baseline audiometry might be expressed as follows:
“I am going to place these headphones on your ears. You will hear a whistle or beeping sound that may be loud or soft. Whenever you hear or think you hear one of these sounds, raise your hand (or press the response switch button) and lower your hand (or release the button) when you do not.”

34. Cleaning Instructions from the Operating Instructions Manual for the Maico MA 39 Pure Tone Audiometer
First, disconnect the power cord before cleaning.
Clean the instrument, headphones, and other accessories with a soft cloth dampened with a little warm, soapy water. Do not use alcohol to clean.
The ear cushions of the headphones can be detached for cleaning.
To remove, gently pull the cushion away from the headphone.
To re-assemble, press it back onto the headphone
Make sure that the sound outlet hole sits exactly in the middle of the earphone.

35. Have a “Cheat Sheet”

37. Referral Most nurses typically rescreen prior to referral
Give specific information in the referral form so the Primary Care Physician and Audiologist know what your findings were, dates of screening and if you rescreened

38. Annie Sargent School in North Andover Screening Area (note Epi=pens on the wall!)

39. Presentation compiled by: Katie Vozeolas, Director of Nursing HAVERHILL PUBLIC SCHOOL DISTRICT